title: Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study.
abstract: OBJECTIVE
  To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance, and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis (PwMS).
  
  
  METHODS
  Prospective cohort study with 6-month follow-up.
  
  
  METHODS
  A multiple sclerosis (MS) physiotherapy clinic.
  
  
  METHODS
  Community-dwelling people (N=210; age range, 21-74y) with MS (Disease Steps 0-5).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Incidence of falls during 6 months' follow-up.
  
  
  RESULTS
  In the 6-month follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice, and 69 (33.0%) fell 3 or more times. Frequent falling (≥3) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A), reduced fine motor control (performance on the 9-Hole Peg Test [9-HPT]), and reported leg pain. Increased sway with the eyes closed, poor coordinated stability, and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers (model χ(2)3=30.1, P<.001). The area under the receiver operating characteristic curve for this model was .712 (95% confidence interval, .638-.785).
  
  
  CONCLUSIONS
  The study reveals important balance, coordination, and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group.
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia.
authors.forename: Phu D
authors.initials: PD
authors.lastname: Hoang
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR; Portland Veteran Affairs Medical Center, Neurology Service, Portland, OR.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Cameron
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Gandevia
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia. Electronic address: s.lord@neura.edu.au.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D000368:Aged; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009103:Multiple Sclerosis / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D009483:Neuropsychological Tests; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D004856:Postural Balance; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014787:Vision Tests
keywords: Accidental falls; Multiple sclerosis; Neuropsychological tests; Postural balance; Rehabilitation; Risk factors